Despite the health of Indigenous people being poorer than that of non-Indigenous people, in 1994 most Indigenous people reported that they were in good health.

By most health status measures, the health of Indigenous people is poorer than that of non-Indigenous people. The life expectancy at birth of Indigenous people is estimated to be 15-20 years less than that of non-Indigenous people, and their death rates are more than double those of non-Indigenous people1. Indigenous people are more likely than non-Indigenous people to suffer from a range of diseases such as diabetes mellitus, respiratory disorders, ear disease, eye disorders, and some cancers2. Disorders of growth and nutrition are prevalent among Indigenous people. However, there have been improvements in some areas of health for Indigenous people since the 1970s3.

Indigenous health

Self-assessed health status refers to the overall level of health reported by Indigenous people aged 13 and over. For people aged less than 13, information was provided by the child's parent or a responsible adult member of the household. Self-assessed health status is not always a reliable indicator of true health status.

Recent illness conditions refer to conditions (illness, injury or disability) experienced in the two weeks prior to interview. They may include long-term conditions experienced in the period.

Long-term illness conditions refer to conditions which had lasted for six months or more.

Health actions refer to activities such as visiting a doctor, taking medication, or changing daily routines in the two weeks prior to interview.

Capital city comprises all state and territory capital city statistical divisions. Other urban comprises all centres with a total population of 1,000 and over, excluding capital cities. Rural comprises rural areas and towns with a total population of less than 1,000 people. Most remote Indigenous communities are included in this category.

Causes of deathAfter standardising for the difference in the age structure of the population, the Indigenous death rate in 1994 was 1,959 per 100,000 population compared to 710 per 100,000 for the total population. Ischaemic heart disease was the leading cause of Indigenous deaths, followed by respiratory diseases, cancer and stroke. These four causes were also the main causes of death in the total population, but in a different order with cancer leading and respiratory diseases fourth.

CAUSES OF DEATH PER 100,000 POPULATION, 1994

Indigenous people(a)

All people

Cause of death

rate

rate

Ischaemic heart disease

377.4

171.4

Respiratory diseases

267.0

55.8

Cancer

237.2

188.7

Stroke

231.9

72.0

Diabetes

139.2

15.4

Other heart disease

125.8

43.1

Road traffic accidents

47.9

11.0

Suicide

20.5

12.7

All deaths

1,958.9

710.2

(a) Indigenous deaths data are for WA, SA, NT and ACT only. Indigenous age-specific death rates are standardised to the 1994 total Australian population.

Source: Causes of Death, Australia (unpublished data)

Self-assessed health statusIn 1994, 32% of Indigenous people reported their health as good and 32% reported it as very good. A further 24% reported their health as excellent. Indigenous men were more likely than Indigenous women to report their health as excellent or very good.

A person's self-assessed health status varies according to many factors, such as their awareness and expectations of health and their level of health relative to other people in their community. However, there is also a link between self-assessed health status and illness. In 1994, Indigenous people who reported suffering an illness were more likely than those who had not reported an illness to assess their health status as fair or poor. Among those who reported suffering an illness condition, those with a long-term illness were more likely than those with a recent illness to report their health status as fair or poor.

The overall aim of the National Aboriginal Health Strategy (NAHS) is to provide all Indigenous people with the same level of access to health services and facilities as other Australians by the year 2001. The specific goals of the strategy are:

to improve health standards and raise life expectancy;

to provide better access to health services, including hospitals and health clinics;

to provide better housing;

to provide power, water, sewerage and roads in communities;

to provide a high level of participation in health decision-making processes, including representation on hospital boards and in national forums;

to provide training and employment for Indigenous people in health-related work;

to provide better support in the areas of information, education, training, research and evaluation;

for state and territory governments to provide culturally appropriate drug and alcohol counselling services, complemented by commonwealth initiatives in the prevention area.

Illness experiencedIn 1994, 41% of Indigenous people reported that they had experienced a recent illness. Men and women reported similar rates of occurrence of recent illness. The recent illness conditions that people reported may have been related to a long-term illness condition.

The most commonly reported recent illness conditions were diseases of the respiratory system (35%). This includes conditions such as asthma, bronchitis and emphysema, as well as minor illnesses such as colds and sore throats.

In 1994, 35% of Indigenous people reported that they suffered from a long-term illness condition. The most common long-term illness condition was asthma (13%), followed by ear or hearing problems (9%) and high blood pressure (6%). Females were slightly more likely than males to report suffering from most long-term illness conditions.

The type of illness that people suffer can be affected by their participation in health risk behaviours. For example, diseases of the respiratory system, which were the most common recent illnesses among Indigenous people, are affected by health risk behaviours such as smoking. In 1994, half of all Indigenous people aged 13 and over were smokers (see Health risk factors and Indigenous people).

The type of illness that a person suffers also varies according to their age. For example, long-term illnesses such as heart problems, diabetes and high blood pressure were most common among Indigenous people aged 45 and over. The presence of such conditions may also be related to factors such as poor diet and lack of exercise.

INDIGENOUS PEOPLE WHO EXPERIENCED A RECENT ILLNESS, 1994

Males

Females

Persons

Type of illness experienced

%

%

%

Diseases of the respiratory system

33.6

35.4

34.5

Symptoms, signs and ill-defined conditions

16.6

19.7

18.2

Injury and poisoning

16.0

8.6

12.1

Diseases of the circulatory system

9.4

12.3

10.9

Diseases of the nervous system and sense organs

9.9

9.7

9.8

Diseases of the skin and subcutaneous tissue

9.2

8.4

8.9

Diseases of the musculoskeletal system and connective tissue

9.2

7.8

8.4

Total Indigenous people who experienced a recent illness(a)

39.9

42.5

41.2

(a) Includes people who suffered other illness conditions. People may have reported more than one type of illness.

Health actionsIn 1994, 44% of Indigenous people took some health action, such as seeing a health professional or taking medication, in the two weeks prior to the survey. The most common action was taking medication (32%). This was followed by consulting a doctor (19%) and reducing daily activities (13%). Females were more likely than males to have undertaken a health action (47% compared to 42%).

Indigenous people living in capital cities were more likely than those living in other urban or rural areas to take a health action. This may be due to better access to health facilities, as well as to higher levels of health education among Indigenous people living in capital cities.

The actions undertaken by Indigenous people also varied according to geographic location. Indigenous people living in rural areas were less likely to consult a doctor than those living in capital cities or other urban areas. However, they were more likely to visit an emergency or outpatients clinic, consult an Aboriginal health worker or consult a nurse. This may be due to differences in access to various types of health services. People in rural areas are less likely than those living in capital cities or other urban areas to have access to a doctor.

HEALTH ACTIONS UNDERTAKEN BY INDIGENOUS PEOPLE, 1994

Capital cities

Other urban

Rural

Total

Type of health action taken

%

%

%

%

Used medication

40.9

30.9

25.8

32.1

Consulted doctor

26.3

17.9

13.1

18.8

Reduced daily activities

16.8

12.2

9.2

12.6

Visited emergency/ outpatients clinic

5.8

8.5

8.8

7.8

Consulted Aboriginal health worker

2.7

4.8

10.6

6.0

Consulted nurse

3.5

4.1

8.6

5.3

Used bush medicine

3.0

2.5

6.1

3.7

Was admitted to hospital

1.8

2.5

3.1

2.5

Total who took a health action(a)

53.0

42.1

39.8

44.4

(a) Percentages do not add to total because people may undertake more than one type of health action.

Access to health servicesIn 1994, 89% of Indigenous households had permanent access (access at least 3 days per week) within 25km to a nurse, 82% had access to a doctor, 80% to a baby health service and 69% to a dentist.

Indigenous people living in rural areas were less likely to have permanent access within 25km to health services than those living in urban areas. In 1994, 41% of Indigenous households in rural areas had access to a doctor, compared to 96% of Indigenous households in capital cities and 95% in other urban areas. However, the majority (70%) of Indigenous households in rural areas had access to a nurse.

Many people who do not have permanent access to various health services have visiting access, which is access between 2 days per week and once a month. Visiting access is particularly important in rural areas where 39% of households had visiting access within 25km to a doctor or GP, and 33% to baby health services.

An important type of visiting health care, especially in rural areas, are flying medical services. In 1994, 21% of Indigenous people had access to flying medical services. As expected, a greater proportion of Indigenous people in rural areas (43%) than those in capital cities (3%) or other urban areas (23%) had access to flying medical services.

The availability of transport also affects a person's access to various health services. For example, a person who has no transport and lives 25km from a permanent health service is likely to have more difficulty accessing the service than a person who lives further away but has a car or regular public transport service available. In addition, the type of health service a person has access to may not be an accurate measure of the service they obtain. For example, a nurse working in an area where there are only limited health services may perform some duties that another health professional would normally perform. Therefore, if a person does not have access to a baby health service they may still have access to a doctor or nurse who can provide similar services.

HOUSEHOLDS WITH ACCESS(a) TO HEALTH SERVICES WITHIN 25KM, 1994

Capital city

Other urban

Rural

Total

Permanent

Visiting

Permanent

Visiting

Permanent

Visiting

Permanent

Visiting

Type of health service

%

%

%

%

%

%

%

%

Nurse

93.0

6.1

96.5

1.8

70.0

8.4

89.1

4.8

Doctor/GP

95.7

4.3

94.8

3.8

41.3

38.9

82.4

12.3

Baby health services

96.9

2.1

86.2

10.7

45.0

32.7

80.0

13.1

Dentist

96.3

* *

75.8

9.2

18.5

24.8

69.0

9.9

Aboriginal health worker

74.8

7.8

73.5

10.9

47.7

16.5

67.8

11.2

Mental health services

83.1

4.3

58.8

15.6

13.6

10.1

56.1

10.6

Flying medical services

. .

2.7

. .

22.8

. .

43.2

. .

21.0

(a) Permanent access is available at least 3 days per week and visiting access is available between 2 days per week and once a month. This question was asked on the community form, not on the household form, and the answers were applied to all the households in the community.

Attitudes to health servicesIn 1994, most of Indigenous people aged 13 and over reported that they had no problems with their local health service. Of those who did report problems, the most commonly reported problem was having to wait too long for treatment (55%), followed by inadequate facilities or staffing (22%) and inadequate hours of operation (14%).

Females were more likely than males to report problems with their local health services. This is probably because females are more likely to use their local health services. People in rural areas were more likely than people in the capital cities or other urban areas, to report problems with their local health services. This is related to lower levels of access to health services in rural areas.

Endnotes1 Australian Institute of Health and Welfare (1995) Australian health trends, 1995.

2 National Health Strategy (1992) Enough to make you sick: How income and environment affect health Research Paper No. 1, September 1992.

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